Healthcare Provider Details

I. General information

NPI: 1932419421
Provider Name (Legal Business Name): MEDCARE HOSPITALITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 S LOWELL RD
BAHAMA NC
27503-8799
US

IV. Provider business mailing address

PO BOX 356
BAHAMA NC
27503-0356
US

V. Phone/Fax

Practice location:
  • Phone: 919-479-9777
  • Fax:
Mailing address:
  • Phone: 919-479-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. TEIJI KIMBALL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 919-479-9777